Biliopancreatic diversion in Poland.

Biliopancreatic diversion (BPD) is a bariatric operation of proved efficacy especially in patients with metabolic comorbidities. The aim was to assess the results of BPD in relation to weight loss and coexisting lipid and glucose metabolism disturbances in the Polish population. Between October 2001 and December 2003 57 morbidly obese patients (24 male and 33 female) underwent BPD. Median age was 46 years (range: 17-58) and median body mass index (BMI) was 50.2 kg/m(2) (range: 40.1-73 kg/m(2)). Type 2 diabetes mellitus was observed in 11 patients (19.3%), hypercholesterolaemia in 38 patients (66.7%) and hypertriglyceridaemia in 37 patients (64.9%). Median value of BMI decreased at three months to 40.0 kg/m(2), at six months to 36.7 kg/m(2), and after a year to 32.3 kg/m2. Diabetes was completely resolved in all patients. After six months, triglycerides and cholesterol levels were higher than normal only in one patient. Early specific complications that manifested as seroma and nosocomial pneumonia occurred in 5.3% and 3.5% patients, respectively. The following specific late complications were observed: ulceration of stomach stump (3.4%), anaemia (14.0%), hypoalbuminaemia (8.8%), deterioration of haemorrhoids (15.8). All of above complications were treated conservatively expect two haemorrhoidectomies. One patient died due to myocardial infarction eight months after BPD. Five cases of incisional hernias (8.8%) were found. BPD is an effective bariatric procedure also in the Polish population, resulting not only in weight loss but also in the improvement of lipid and glucose metabolism.

[A trial of progressive supranuclear palsy with carbamazepine]. / Próba zastosowania karbamazepiny w postepujacym porazeniu nadjadrowym.

We present a 61-year old patient with diagnosis of progressive supranuclear palsy. 2 years after the beginning of her complaints the diagnosis was based on the results of neurological examination. The ENG examination (among others vertical gaze paralysis) and the MR examination (2 of 3 criteria were met). The course of the disease was complicated by epilepsy and the treatment with carbamazepine was commenced. A significant improvement of her neurological and mental status was observed. The authors suggest checking this observation on larger number of patients with PSP.

[The case of neurofibromatosis type ! in a 5-year-old boy]. / Przypadek nerwiakowlókniakowatosci u 5-letniego chlopca.

In the work we present the case of a 5-year-old boy who was admitted to the clinic because of the tumour in mediastinum. According to the results of the investigation the diagnosis of Recklinghausen disease was made. The tumour was situated in the region of pharynx, neck and mediastinum. The diagnosis was based on the characteristic features in the physical examination (café-au-laît spots, freckles in armpits and grains) and accessory investigations (x-ray, CT, NMR and histopathology). In the boy's family this disease was not noticed, although in his mother we observed café-au-laît spots on the skin of abdomen. Despite the fact that the diagnosed disease is known as a mild one (from the histopathological point of view) in the case of our patient it turned out to be much more clinically malignant because of the localization of the tumour. This situation forced us to the application of much more aggressive treatment (chemotherapy, operation).